吻合器痔上粘膜环切钉合、肛垫复位术治疗Ⅲ—Ⅳ度内痔的临床观察
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摘要
目的：观察PPH手术治疗Ⅲ—Ⅳ度痔的临床疗效。
方法：将120例患者采用简单随机的方法分为试验组和对照组各60例；试验组采用PPH手术，对照组采用外剥内扎硬化注射术。观察2周，随访3月。
结果：两组有效率无明显差异，试验组有效率为98.3％，对照组为93.3％。但试验组术后脱垂物能很快回缩，术后疼痛、肛缘水肿、感觉性肛门失禁的发生率明显低于对照组(P＜0.01)；住院时间及恢复工作的时间较对照组有显著差异。
结论：PPH手术近期疗效优于传统手术，且在正确的手术操作下，痛苦小，恢复快，术后不适少，对肛门功能影响小，对手术者的要求较低。
Objection To observe the clinic effect of PPH treating III-IV degree hemorrhoids.
Methods One hundred and twenty cases admitted for surgical treatment were randomly classed for test group (PPH, n=60) and controlled group (external excision and internal ligation and sclerotherapy, n=60). All the cases were observed two weeks and followed up three months.
Results The efficiency rate of the two group has no dominant indifference. The test group is 98.3% and the controlled group is 93.3%. The prolapse rapidly went back in few minutes after operation in PPH. The morbility of postoperative pain, edema of anal edge, anal sensory incontinence in PPH is dominantly lower to the controlled group (P<0. 01) . The hospitalization time and recovery time in PPH group is shorten to the controlled group.
Conclusion The shorter-term outcome of PPH is superior to conventional operation's, and the PPH has little postoperative pain, quickly recovery , little postoperative discomfort , little compression to anal function under the correct operation procedure.
方法：将120例患者采用简单随机的方法分为试验组和对照组各60例；试验组采用PPH手术，对照组采用外剥内扎硬化注射术。观察2周，随访3月。
结果：两组有效率无明显差异，试验组有效率为98.3％，对照组为93.3％。但试验组术后脱垂物能很快回缩，术后疼痛、肛缘水肿、感觉性肛门失禁的发生率明显低于对照组(P＜0.01)；住院时间及恢复工作的时间较对照组有显著差异。
结论：PPH手术近期疗效优于传统手术，且在正确的手术操作下，痛苦小，恢复快，术后不适少，对肛门功能影响小，对手术者的要求较低。
Objection To observe the clinic effect of PPH treating III-IV degree hemorrhoids.
Methods One hundred and twenty cases admitted for surgical treatment were randomly classed for test group (PPH, n=60) and controlled group (external excision and internal ligation and sclerotherapy, n=60). All the cases were observed two weeks and followed up three months.
Results The efficiency rate of the two group has no dominant indifference. The test group is 98.3% and the controlled group is 93.3%. The prolapse rapidly went back in few minutes after operation in PPH. The morbility of postoperative pain, edema of anal edge, anal sensory incontinence in PPH is dominantly lower to the controlled group (P<0. 01) . The hospitalization time and recovery time in PPH group is shorten to the controlled group.
Conclusion The shorter-term outcome of PPH is superior to conventional operation's, and the PPH has little postoperative pain, quickly recovery , little postoperative discomfort , little compression to anal function under the correct operation procedure.
引文
(1) 张东铭·痔病的病因与流行病学·大肠肛门病外科杂志，2002，8：25。
(2) Loder PB, Kamm MA, Nicholls R J, Phillips RKS. Haemorrhoids: pathology, pathophysiology and aetiology, Br J Surg. 1994; 81:946-954,
(3) 张东铭·痔的现代概念·中华胃肠外科杂志，2001，4：58-60。
(4) Thomson WHF·The nature of haemorrhoids·Br J Surg, 1975,62:542-552.
(5) Brian J, John RT, John EH, et al·Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randonised controlled trial[J]·Lancet, 2000,355:1020-1030.
(6) Pescatori M, Favetta U, Dedola S, et al·Transanal stapled excision of rectal mucose prolapse[J]·Tech Coloproct, 1997,1:96-98.
(7) 张东铭，王玉成·盆底与肛门病学·贵州科技出版社，2001，106。
(8) Polglase A·Haemorrhoids: a clinical update·Med J Aust, 1997;167: 85-88.
(9) Seow-Choen F·Stapled haemorrhoidectomy: pain or gain·Br J Srug,2001, 88: 1-3.
(10) Norman Sohn, M.D., Jeffrey S. Aronoff, M.D., Frank S. Cohen, M.D., et, al·Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy·The American Journal of Surgery, 2001,182:515-519.
(11) G. C. Beattie and M.A. Loudon·Follow-up confirms sustained benefit of circumferential stapled anoplasty in the managementof prolapsing haemorrhoids·British Journal of Surgery, 2001,88:850-852.
(12) Boccasanta P, Capretti PG, Venturi M, et al·Randomised
controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse, Am J Surg, 2001, 182:64-68.
(13) Brown SR, Ballan K, Ho E, Ho Fams YH, Seow-Choen F·Stapled mucosectomy for acute thrombosed circumferentially prolapsed pilles: a prospective randomized comparison with conventional haemorrhoidectomy·Colorectal Dis, 2001,3:175-178.
(14) Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S·Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy·Br J Surg, 2001,88:669-674.
(15) Ho Y-H, Cheong W-K, Tsang C, Ho J, Tang C-L, Seow-Choen F·Stapled hemorrhoidectom~- cost and effectiveness: randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months·Dis Colon Rectum, 2000,43:1666-1675.
(16) Mehigan BJ, Monson JR, Hartley JE·Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trial·Lancet,2001,355:782-785.
(17) Rowsell M, Bello M, Hemingway DM·Circumferential mucosectomy(stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomized conrolled trial·Lanced, 2001,355:779-781.
(18) National Health and Medical Research Council·How to Use the Evidence: Assessment and application of Scientific Evidence·Canberra, Australia: National Health and Medical Research Council, 2000:8.
(19) Cheetham MJ, Mortensen NJ, Nystrom PO, Kamm MA, Phillips RK·Persistent pain and faecal urgency after stapled haemorrhoidectomy·Lancet, 2001,356:730-733.
(20) Polglase A, Winnett JD·Check the stapler before use·A N Z J Surg, 2001,69:402-403.
(21) Lam TY, Lam SC, Kwok SP. Feasibility case-controlled study of day-case haemorrhoidectomy·A N Z J Surg, 2001,71:652-654.
(22) Luigi Maria Pernice, M.D., Barabara Bartalucci, M.D. et al·Early and later(ten years) experience with circular stapler hemorrhoidectomy·Dis Colon Rectum, 2001, 7: 836-841.
(23) Y.- H. Ho, F. Seow-Choen, C. Tsang and K.- W. Eu·Randomized trial assessing anal sphincter injuries after stapled haemorrhoidectomy·British Journal of Surgery, 2001,88:1449-1455.
(24) 任东林·PPH手术治疗痔病的适应证及应用注意事项·大肠肛门病外科杂志，2003(9)：7-8。
(25) 刘金林·吻合器痔上直肠粘膜环切除术致术中、术后出血的应对策略·消化外科，2002，1(5)：340-341。
(2) Loder PB, Kamm MA, Nicholls R J, Phillips RKS. Haemorrhoids: pathology, pathophysiology and aetiology, Br J Surg. 1994; 81:946-954,
(3) 张东铭·痔的现代概念·中华胃肠外科杂志，2001，4：58-60。
(4) Thomson WHF·The nature of haemorrhoids·Br J Surg, 1975,62:542-552.
(5) Brian J, John RT, John EH, et al·Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randonised controlled trial[J]·Lancet, 2000,355:1020-1030.
(6) Pescatori M, Favetta U, Dedola S, et al·Transanal stapled excision of rectal mucose prolapse[J]·Tech Coloproct, 1997,1:96-98.
(7) 张东铭，王玉成·盆底与肛门病学·贵州科技出版社，2001，106。
(8) Polglase A·Haemorrhoids: a clinical update·Med J Aust, 1997;167: 85-88.
(9) Seow-Choen F·Stapled haemorrhoidectomy: pain or gain·Br J Srug,2001, 88: 1-3.
(10) Norman Sohn, M.D., Jeffrey S. Aronoff, M.D., Frank S. Cohen, M.D., et, al·Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy·The American Journal of Surgery, 2001,182:515-519.
(11) G. C. Beattie and M.A. Loudon·Follow-up confirms sustained benefit of circumferential stapled anoplasty in the managementof prolapsing haemorrhoids·British Journal of Surgery, 2001,88:850-852.
(12) Boccasanta P, Capretti PG, Venturi M, et al·Randomised
controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse, Am J Surg, 2001, 182:64-68.
(13) Brown SR, Ballan K, Ho E, Ho Fams YH, Seow-Choen F·Stapled mucosectomy for acute thrombosed circumferentially prolapsed pilles: a prospective randomized comparison with conventional haemorrhoidectomy·Colorectal Dis, 2001,3:175-178.
(14) Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S·Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy·Br J Surg, 2001,88:669-674.
(15) Ho Y-H, Cheong W-K, Tsang C, Ho J, Tang C-L, Seow-Choen F·Stapled hemorrhoidectom~- cost and effectiveness: randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months·Dis Colon Rectum, 2000,43:1666-1675.
(16) Mehigan BJ, Monson JR, Hartley JE·Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trial·Lancet,2001,355:782-785.
(17) Rowsell M, Bello M, Hemingway DM·Circumferential mucosectomy(stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomized conrolled trial·Lanced, 2001,355:779-781.
(18) National Health and Medical Research Council·How to Use the Evidence: Assessment and application of Scientific Evidence·Canberra, Australia: National Health and Medical Research Council, 2000:8.
(19) Cheetham MJ, Mortensen NJ, Nystrom PO, Kamm MA, Phillips RK·Persistent pain and faecal urgency after stapled haemorrhoidectomy·Lancet, 2001,356:730-733.
(20) Polglase A, Winnett JD·Check the stapler before use·A N Z J Surg, 2001,69:402-403.
(21) Lam TY, Lam SC, Kwok SP. Feasibility case-controlled study of day-case haemorrhoidectomy·A N Z J Surg, 2001,71:652-654.
(22) Luigi Maria Pernice, M.D., Barabara Bartalucci, M.D. et al·Early and later(ten years) experience with circular stapler hemorrhoidectomy·Dis Colon Rectum, 2001, 7: 836-841.
(23) Y.- H. Ho, F. Seow-Choen, C. Tsang and K.- W. Eu·Randomized trial assessing anal sphincter injuries after stapled haemorrhoidectomy·British Journal of Surgery, 2001,88:1449-1455.
(24) 任东林·PPH手术治疗痔病的适应证及应用注意事项·大肠肛门病外科杂志，2003(9)：7-8。
(25) 刘金林·吻合器痔上直肠粘膜环切除术致术中、术后出血的应对策略·消化外科，2002，1(5)：340-341。